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Subject: Health

  • What we must consider before digitising India’s healthcare

    As India seeks to create digital health infrastructure, it must consider several issues.

    Integrated digital health infrastructure

    • The National Digital Health Mission aims to develop the backbone needed for the integrated digital health infrastructure of India.
    • This can help not only with diagnostics and management of health episodes, but also with broader public health monitoring, socio-economic studies, epidemiology, research, prioritising resource allocation and policy interventions. 
    • However, before we start designing databases and APIs and drafting laws, we must be mindful of certain considerations for design choices and policies to achieve the desired social objectives.

    Factors to be considered

    1) Carefully developing pathway to public good

    • There must be a careful examination of how exactly digitisation may facilitate better diagnosis and management, and an understanding of the data structures required for effective epidemiology.
    • We must articulate how we may use digitisation and data to understand and alleviate health problems such as malnutrition and child stunting.
    • We need the precise data we require to better understand crucial maternal- and childcare-related problems.

    2) Balancing between public good and individual rights

    • The potential tensions between public good and individual rights must be examined, as must the suitable ways to navigate them.
    • Moreover, for the balancing to be sound and for determining the level of due diligence required, it is imperative to clearly define the operational standards for privacy management.
    • Conflating privacy with security, as is typical in careless approaches, will invariably lead to problematic solutions.
    • In fact, most attempts at building health data infrastructures worldwide — including in the UK, Sweden, Australia, the US and several other countries — have led to serious privacy-related controversies and have not yet been completely successful.

    3) Managing the sector specific identities

    • Even if we define and use a sector-specific identity, the question of when and how to link it with that of other sectors remains.
    • For example, with banking or insurance for financial transactions, or with welfare and education for transactions and analytics.
    • Indiscriminate linking may break silos and create a digital panopticon, whereas not linking at all will result in not realising the full powers of data analytics and inference.

    4) Working out the operational requirement of data infrastructure

    • We need to work out the operational requirements of the data infrastructure in ways that are informed by, and consonant with, the previous points.
    • In other words, the design of the operationalisation elements must follow the deliberations on above points, and not run ahead of them.
    • This requires identifying the diverse data sources and their complexity — which may include immunisation records, birth and death records, informal health care workers, dispensaries etc.
    • It also requires an understanding of their frequency of generation, error models, access rights, interoperability, sharing and other operational requirements.
    • There also are the complex issues of research and non-profit uses of data, and of data economics for private sector medical research.

    5) Issue of due process

    • Finally, “due process” has always been a weak point in India, particularly for technological interventions.
    • Building an effective system that can engender people’s trust not only requires managing the floor of the Parliament and passing a just and proportional law, but also building a transparent process of design and refinement through openness and public consultations.
    • In particular, technologists and technocrats should take care to not define “public good” as what they can conveniently deliver, and instead understand what is actually required.
    • While we can understand the urge to move forward quickly, given the urgent need to improve health outcomes in the country, deliberate care is needed.

    Consider the question “While seeking to develop digital health infrastructure through the National Digital Health Mission, we should be mindful of certain considerations for design choices and policies to achieve the desired social objectives. Comment.”

    Conclusion

    Developing a comprehensive understanding of the considerations related to health data infrastructure may also inform the general concerns of e-governance and administrative digitisation in India, which have not been all smooth sailing.

  • What changes after COVID-19 vaccination?

    As the vaccination drive gains momentum, questions have emerged about appropriate behaviour after being vaccinated.

    What does being vaccinated mean?

    • Being fully vaccinated means a period of two weeks or more following the receipt of the second dose in a two-dose series, or two weeks or more following the receipt of a single-dose vaccine.
    • In India, currently, both vaccines being used — Covishield and Covaxin — follow a two-dose regimen.
    • Typically, the immune response takes a while to build up after a vaccine shot.
    • After the first jab of a two-dose vaccine, a good immune response kicks in within about two weeks. It is the second dose that boosts the immune response.

    Is the COVID threat averted?

    • It is still unclear how long immunity lasts from the vaccines at hand now.
    • Whether or not the immune response is durable, how it performs with the passage of time, and how long it lasts can be found out only by monitoring people who have already been vaccinated over a period.
    • If the vaccinated individual is still carrying the virus, the vaccine may provide immunity from severe disease for him or her, but the individual could still transmit the virus.

    What changes after you get a vaccine shot?

    • After vaccination, one risk of severe disease from COVID-19 goes down dramatically.
    • There is not enough evidence yet of vaccine response for some age groups, and vaccines are in short supply in the community.

  • Women’s needs are key to Swachh Bharat success

    The article highlights the central role of women in the success of the Swacch Bharat Mission.

    Recognising the gender dimensions of sanitation in India

    • The Swachh Bharat Grameen Phase I guidelines (2017) state that requirements and sensitivities related to gender are to be taken into account at all stages of sanitation programmes.
    • Planning, procurement, infrastructure creation, and monitoring are the basic tenets of implementation in Swachh Bharat and the guidelines for the first phase of the mission called for strengthening the role of women.
    • The states were accordingly expected to ensure adequate representation of women in the village water and sanitation committees (VWSCs), leading to optimal gender outcomes.
    • The department of Drinking Water and Sanitation released the guidelines, recognising the gender dimensions of sanitation in India.
    • Swachh Bharat Mission 2 .0 speaks of sustained behavioural change while embarking on the newer agendas of sustainable solid waste management and safe disposal of wastewater and reuse.
    • Besides the government, the role of non-state actors like the Bill and Melinda Gates Foundation, Unicef and several NGOs, must be lauded as we pursue sustainable sanitation using a powerful gender lens.

    Challenges and solutions

    • There were inevitably cases where women were fronts for spouses.
    • This capturing has happened in panchayat seats as well but research has shown that over time, women do pick up the challenge, and if voted back are likely to assume charge.
    • The government has also very effectively used over 8 lakh swachhagrahis, mainly women, who for small honorariums work to push through behavioural change at the community level.
    • There are no quick solutions other than adopting concerted approaches to ensure the survival and protection of the girl child through good health from sanitation and nutrition.
    • Information, education, and communication, which aims at behaviour change of the masses, is key to the success of the swachhta mission 2.0.
    • Changes in SBM messaging reflects major transformations attempting to popularise and portray stories of women groups and successful women swachhta champions.

    Need for monitoring and evaluation system

    • A national monitoring and evaluation system to track and measure gender outcomes in SBM is necessary.
    • Several researchers in this space have commented that gender analysis frameworks have a long history in development practice.
    • We can learn from these frameworks to support design, implementation, and measurement.

    Conclusion

    There is no doubt that women can help to drive change and bring about lasting change as the jan andolan for swachhta, health and sanitation gains momentum.

  • Intensified Mission Indradhanush (IMI) 3.0

    States and UTs have started the implementation of the Intensified Mission Indradhanush 3.0, a campaign aimed to reach those children and pregnant women who have been missed out or been left out of the routine immunisation.

    Do not get confused with the Mission Indradhanush for Public Sector Banks launched in 2015. It aims at revamping the functioning of the Public Sector Banks to enable them to compete with the Private Sector Banks.

    Intensified Mission Indradhanush (IMI) 3.0

    • IMI 3.0 is aimed to accelerate the full immunization of children and pregnant women through a mission mode intervention.
    • The campaign is scheduled to have two rounds of immunisation lasting 15 days (excluding routine immunisation and holidays).
    • It is being conducted in pre-identified 250 districts/urban areas across 29 States/UTs in the country.
    • Beneficiaries from migration areas and hard to reach areas will be targeted as they may have missed their vaccine doses during the pandemic.

    About the Mission Indradhanush

    • Mission Indradhanush seeks to drive towards 90% full immunisation coverage of India and sustain the same by the year 2020. It was launched in December 2014.

    Aims and objectives

    • It aims to immunize all children under the age of 2 years, as well as all pregnant women, against eight vaccine-preventable diseases.
    • The diseases being targeted are diphtheria, whooping cough, tetanus, poliomyelitis, tuberculosis, measles, meningitis and Hepatitis B.
    • In 2016, four new additions have been made namely Rubella, Japanese Encephalitis, Injectable Polio Vaccine Bivalent and Rotavirus.
    • In 2017, Pneumonia was added to the Mission by incorporating the Pneumococcal conjugate vaccine under Universal Immunisation Programme

    Try this question from CSP 2016:

    Q.‘Mission Indradhanush’ launched by the Government of India pertains to:

    (a) Immunization of children and pregnant women

    (b) Construction of smart cities across the country

    (c) India’s own search for the Earth-like planets in outer space

    (d) New Educational Policy

  • What are Non-Alcoholic Fatty Liver Diseases (NAFLD)?

    The Union Govt has integrated the Non-alcoholic fatty liver disease (NAFLD) in the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke.

    Try this MCQ:

    Q.A Company marketing food products advertises that its items do not contain trans-fats. What does this campaign signify to the customers?

    1. The food products are not made out of hydrogenated oils.
    2. The food products are not made out of animal fats/oils.
    3. The oils used are not likely to damage the cardiovascular health of the consumers.

    Which of the statements given above is/are correct?

    (a) Only 1

    (b) 2 and 3 only

    (c) 1 and 3 only

    (d) 1, 2 and 3

    NAFLD

    • NAFLD is the abnormal accumulation of fat in the liver in the absence of secondary causes of fatty liver, such as harmful alcohol use, viral hepatitis, or medications.
    • According to doctors, it is a serious health concern as it encompasses a spectrum of liver abnormalities.
    • It can cause non-alcoholic fatty liver (NAFL, simple fatty liver disease) to more advanced ones like non-alcoholic steatohepatitis (NASH), cirrhosis and even liver cancer.

    Why such a move?

    • NAFLD is emerging as an important cause of liver disease in India.
    • Epidemiological studies suggest the prevalence of NAFLD is around 9% to 32% of the general population in India with a higher prevalence in those with overweight or obesity and those with diabetes or prediabetes.
    • Researchers have found NAFLD in 40% to 80 % of people who have type 2 diabetes and in 30% to 90% of people who are obese.
    • Studies also suggest that people with NAFLD have a greater chance of developing cardiovascular disease.
    • Cardiovascular disease is the most common cause of death in NAFLD.

  • vaccine hesitancy

    Reluctance to take the vaccine has several implications. The misinformation around the vaccines needs to be fought through several measures. 

    Understanding vaccine hesitancy

    • According to the World Health Organization, vaccine hesitancy is defined as a reluctance or refusal to vaccinate despite the availability of vaccine services.
    • To date, two vaccines have been approved for inoculation in India: Pune-based Serum Institute’s Covishield and Hyderabad-based Bharat Biotech’s Covaxin.
    • An adequate supply of vaccines is in place at least for the first phase, but the trickier part is to persuade the population for vaccination.
    • Like Western nations, vaccine hesitancy has been a cause of concern in the past in India as well.
    • Social media has seen a rising number of self-proclaimed experts who have been making unsubstantiated claims.
    • The debates around hesitancy for COVID-19 vaccines include concerns over safety, efficacy, and side effects due to the record-breaking timelines of the vaccines, competition among several companies, misinformation, and religious taboos.

    Need to adopt libertarian paternalism

    • It is suggested that we adopt the idea of libertarian paternalism, which says it is possible and legitimate to steer people’s behaviour towards vaccination while still respecting their freedom of choice.
    • Vaccine hesitancy has a different manifestation in India, unlike in the West.
    • According to the World Economic Forum/Ipsos global survey, COVID-19 vaccination intent in India, at 87%, exceeds the global 15-country average of 73%.

    Way forward

    • Instead of anti-vaxxers, the target audience must be the swing population i.e., people who are sceptical but can be persuaded through scientific facts and proper communication.
    • The second measure is to pause before you share any ‘news’ from social media.
    • It becomes crucial to inculcate the habit of inquisitive temper to fact-check any news related to COVID-19 vaccines.
    • The third measure is to use the celebrity effect — the ability of prominent personalities to influence others to take vaccines.
    • Celebrities can add glamour and an element of credibility to mass vaccinations both on the ground and on social media.

    Consider the question “What is vaccine hesitancy? Suggest the measures to deal with it”

    Conclusion

    The infodemic around vaccines can be tackled only by actively debunking myths, misinformation and fake news on COVID-19 vaccines.

  • [pib] National Creche Scheme

    The Union Minister of Women and Child Development have given information about the National Creche Scheme to the Lok Sabha.

    Try this PYQ:

    Q.Which of the following statements is/are correct regarding the Maternity Benefit (Amendment) Act, 2017?

    1. Pregnant women are entitled to three months pre-delivery and three months post-delivery paid leave.
    2. Enterprises with creches must allow the mother a minimum of six crèche visits daily.
    3. Women with two children get reduced entitlements.

    Select the correct answer using the code given below.

    (a) 1 and 2 only

    (b) 2 only

    (c) 3 only

    (d) 1, 2 and 3

    National Creche Scheme

    • The Ministry of WCD implements the NCS for the children of working mothers as a Centrally Sponsored Scheme through States/ UTs with effect from 01.01.2017.
    • It aims to provide daycare facilities to children (age group of 6 months to 6 years) of working mothers.

    The Scheme provides an integrated package of the following services:

    • Daycare facilities including sleeping facilities.
    • Early stimulation for children below 3 years and pre-school education for 3 to 6 years old children
    • Supplementary nutrition (to be locally sourced)
    • Growth monitoring
    • Health check-up and immunization

  • What is Immunity Passport?

    In a bid to ease travel restrictions amid the coronavirus pandemic, countries like Denmark, Estonia, Israel, Chile, UK have announced a new ‘immunity passport.’

    Try this question form mains:

    Q.Discuss various ethical issues evolved during the outbreaks of pandemics (of the scale of COVID-19).

    Immunity Passport

    • They are the recovery or release certificate or a document attesting that its bearer is immune to a contagious disease.
    • The concept has drawn much attention during the COVID-19 pandemic as a potential way to contain the pandemic and permit faster economic recovery.
    • The can be used as a legal document granted by a testing authority following a serology test demonstrating that the bearer has antibodies making them immune to a disease.

    Ethical issues involved

    • Issuing ‘immunity certificates’ to people who have recovered can be an ethical minefield.
    • Doctors do not generally prefer immunity to be induced by natural infection compared with vaccines. It seems logical, but there are multiple challenges.
    • There might be long-term health complications in those who had COVID-19, whereas the vaccine will have minimal or no adverse health consequences.
    • There is a danger that similar arguments will be made for other vaccine-preventable diseases for which we have a universal immunisation programme.

    Public health risk

    • People whose livelihood has have been affected would be encouraged to adopt risky behaviour so as to get infected rather than taking precautions to stay protected from the virus.
    • This would lead to a sharp increase in cases across the country with huge numbers requiring hospitalization.
    • Such a situation would lead to testing capabilities getting overwhelmed, crumbling of the health-care systems and increased deaths.

    Threats over malpractices

    • Immunity certification will include a system for identification and monitoring, thus compromising privacy.
    • Other contentious issues would be profiteering by private labs performing tests, and the menace of fake certificates which we have already seen in some Indian states.
    • In the end, an immunity passport will further divide the society with different ‘haves’ and ‘have-nots’.

    Way forward

    • We need to look at COVID-19 with a sense of balance and not hysteria.
    • Terms such as immunity passports may not have relevance as we do not know anything about specific kinds of immune responses and the duration of protection in people.
    • There is currently not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an ‘immunity passport’ or ‘risk-free certificate’.
    • The permission to travel or work should be decided on a case by case basis, according to the principles of ethics while dealing with a pandemic.

  • First steps in India’s journey to universal health care

    The article highlights the issues with India’s approach in achieving universal health care and issues with it.

    Learning from the experience of Thailand

    • About 20 years ago, Thailand rolled out universal health coverage at a per capita GDP similar to today’s India.
    • What made this possible was a three decade-long tradition of investing gradually but steadily in public health infrastructure and manpower.
    • This meant that alongside the availability of funds, there also existed robust institutional capacity to assimilate those funds.
    • This is important because enough evidence exists on weak fund-absorbing capacities particularly in the backward States in India.

    Budgetary allocations for health

    • The Union Ministry of Health and Family Welfare budget for 2021-22, viz. ₹73,932 crore, saw a 10.2% increase over the Budget estimate (BE) of 2020-21.
    • Also, a corpus of ₹64,180 crore over six years has been set aside under the PM Atma Nirbhar Swasth Bharat Yojana, (PMANSBY).
    • ₹13,192 crore has been allocated as a Finance Commission grant.
    • These allocations could make the first steps towards sustainable universal health coverage through incremental strengthening of grass-root-level institutions and processes.

    Two important and prominent arms of universal health coverage in India merit discussion here

    1) Insurance route for achieving universal health coverage and issues with it

    • The Pradhan Mantri Jan Arogya Yojana (PM-JAY) has stagnated at ₹6,400 crores for the current and a preceding couple of years.
    • Large expenditure projections and time constraints involved in the input-based strengthening of public health care have inspired the shift to the insurance route.
    • However, insurance does not provide a magic formula for expanding health care with low levels of public spending.
    • Beyond low allocations, poor budget reliability merits attention.
    • Another related issue is the persistent and large discrepancies between official coverage figures and survey figures (for e.g. the National Sample Surveys, or NSS, and National Family Health Survey) across Indian States.
    • Such discrepancies indicate that official public health insurance coverage fails to translate into actual coverage on the ground.
    • Robust research into the implementational issues responsible for such discrepancies and addressing them is warranted.
    • Without the same, the PM-JAY’s quest for universal health coverage is likely to be precarious.
    • Finally, even high actual coverage should not be equated with effective financial protection.
    • For example, Andhra Pradesh has among the highest public health insurance coverage scores (71.36%, NSS 75), but still has an out-of-pocket spending share much above the national average.

    2) Comprehensive primary care

    • Health and Wellness Centres — 1,50,202 of them — offering a comprehensive range of primary health-care services are to be operationalised until December 2022.
    • Of these, 1,19,628 would be upgraded sub health centres and the remaining would be primary health centres and urban primary health centres.
    • Initially, most States prioritised primary health centres/urban primary health centres for upgradation over sub health centres, since the former required fewer additional investments.
    • Till February 2, 58,155 health and wellness centres were operational, of which 34,733 were sub health centres and 23,422 were primary health centres/urban primary health centres.
    • This means that of the remaining 92,047 health and wellness centres to be operationalised by December 2022, 84,895 will be sub health centres.
    • This offers huge cost projections.
    • The current allocation of ₹1,900 crore, an increase of ₹300 crore from previous year, is a paltry sum in comparison.
    • Since 2018-19, when the health and wellness centre initiative began, allocations have not kept pace with the rising targets each year.
    • Additional funding under the PMANSBY and Finance Commission grants is reassuring, but a greater focus on rural health and wellness centres would be warranted.
    • Two untoward implications could result from under-investing and spreading funds too thinly.
    • Continuing the expansion of health and wellness centres without enough funding would mean that the full range of promised services will not be available, thus rendering the mission to be more of a re-branding exercise.
    • Second, under-funding would waste an opportunity for the health and wellness centre initiative to at least partially redress the traditional rural-urban dichotomy by bolstering curative primary care in rural areas.

    Consider the question “What are the challenges in adopting the insurance model in achieving the universal health coverage in India?” 

    Conclusion

    COVID-19 has prodded us to make a somewhat stout beginning in terms of investing in health. The key, and the most difficult part, would be to keep the momentum going unswervingly.

  • FSSAI caps transfats in foods

    The FSSAI has amended its rules to put a cap on trans fatty acids (TFAs) in food products just weeks after it tightened the norms for oils and fats.

    What are the new rules?

    • Food products in which edible oils and fats are used as an ingredient shall not contain industrial Trans fatty acids more than 2% by mass of the total oils/fats present in the product, on and from 1st January 2022.
    • In December, the FSSAI had capped TFAs in oils and fats to 3% by 2021, and 2% by 2022 from the current levels of 5%.
    • The 2% cap is considered to be the elimination of trans fatty acids, which is to be achieved by 2022.

    What are Trans Fats?

    • Trans fatty acids are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid, increase the shelf life of food items and for use as an adulterant as they are cheap.
    • They are present in baked, fried and processed foods as well as adulterated ghee which becomes solid at room temperature.
    • They are the most harmful form of fats as they clog arteries and cause hypertension, heart attacks and other cardiovascular diseases.

    Why need such regulation?

    • As per the World Health Organisation (WHO), approximately 5.4 lakh deaths take place each year globally because of intake of industrially-produced trans-fatty acids.
    • The WHO has called for the elimination of industrially-produced trans-fatty acids from the global food supply by 2023.
    • The latest FSSAI rules signal the completion of the process of regulating trans fats in India.
    • The move will make a big difference in the health harm caused by this unwanted ingredient.
    • This allows FSSAI and the State-level food safety machinery to focus on implementation and enforcement of the WHO recommendations.